Individual provider Active NPI

Marc Andre Panet-Raymond, D.D.S.

  • General Practice Dentistry
  • Salem, OR
National Provider Identifier
1093827503
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D6920 Issued in OR
Practice address
150 Madrona Ave SE
Salem, OR 97302-4608
Phone
(503) 362-3719
Fax
(503) 362-7199
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D6920 OR Primary

Addresses

Primary practice location

150 Madrona Ave SE
Salem, OR 97302-4608

Mailing address

150 Madrona Ave SE
Salem, OR 97302-4608
Phone (503) 362-3719

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160211002722 OR Order and Referring Only - DentistPractitioner - Dentist 2163726167

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D6920ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Transform Sleep LLC General Practice PastSince Apr 13, 2016 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093827503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MADRONA AVE SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024608",
            "telephone_number": "503-362-3719",
            "fax_number": "503-362-7199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MADRONA AVE SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973024608",
            "telephone_number": "503-362-3719",
            "fax_number": "503-362-7199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANET-RAYMOND",
        "first_name": "MARC",
        "middle_name": "ANDRE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.